Care of Patients with Diabetic Foot Disease in Oman

Diabetes mellitus is a major public health challenge and causes substantial morbidity and mortality worldwide. Diabetic foot disease is one of the most debilitating and costly complications of diabetes. While simple preventative foot care measures can reduce the risk of lower limb ulcerations and subsequent amputations by up to 85%, they are not always implemented. In Oman, foot care for patients with diabetes is mainly provided in primary and secondary care settings. Among all lower limb amputations performed in public hospitals in Oman between 2002–2013, 47.3% were performed on patients with diabetes. The quality of foot care among patients with diabetes in Oman has not been evaluated and unidentified gaps in care may exist. This article highlights challenges in the provision of adequate foot care to Omani patients with diabetes. It concludes with suggested strategies for an integrated national diabetic foot care programme in Oman

Care of Patients with Diabetic Foot Disease in Oman

Diabetes mellitus is a major public health challenge and causes substantial morbidity and mortality worldwide. Diabetic foot disease is one of the most debilitating and costly complications of diabetes. While simple preventative foot care measures can reduce the risk of lower limb ulcerations and subsequent amputations by up to 85%, they are not always implemented. In Oman, foot care for patients with diabetes is mainly provided in primary and secondary care settings. Among all lower limb amputations performed in public hospitals in Oman between 2002–2013, 47.3% were performed on patients with diabetes. The quality of foot care among patients with diabetes in Oman has not been evaluated and unidentified gaps in care may exist. This article highlights challenges in the provision of adequate foot care to Omani patients with diabetes. It concludes with suggested strategies for an integrated national diabetic foot care programme in Oman

Diabetic Foot Disease Research in Gulf Cooperation Council Countries: A bibliometric analysis

Objectives: Countries in the Gulf Cooperation Council (GCC) have some of the highest prevalence rates of diabetes mellitus (DM) in the world; however, DM-related research activity in this region is limited. This study aimed to examine trends in published diabetic foot disease (DFD) research undertaken in GCC countries. Methods: This bibliometric study was conducted in December 2016. Standardised criteria were used to search the MEDLINE® database (National Library of Medicine, Bethesda, Maryland, USA) for DFD-related publications authored by GCC researchers between January 1990 and December 2015. Various details such as the type of publication, journal impact factor and number of article citations were analysed. Results: A total of 96 research articles were identified. The number of publications per year significantly increased from nil prior to 1991 to 15 in 2015 (P <0.01). Basic/clinical research articles accounted for 96.9% of publications, with three randomised controlled trials and no systematic reviews/meta-analyses. When adjusted for population size, Kuwait had the highest number of published papers per year, followed by Bahrain and Qatar. The number of authors per publication significantly increased during the study period (P = 0.02). However, 16 articles (16.7%) had no citations. The median journal impact factor was 0.15 ± 1.19 (range: 0–6.04). Conclusion: The number of publications authored by GCC researchers has risen in recent years. Increasing research funding and promoting collaboration between local and international researchers and institutes are recommended to bolster research regarding DFD prevention and management in GCC countries. Keywords: Bibliometric Analysis; Diabetes Mellitus; Diabetic Foot; Research; Publications; Arab Countries; Gulf Cooperation Council

Dietary Pattern Indicators among Healthy and Unhealthy Weight Adolescents Residing in Different Contexts across the Otago Region, New Zealand

Reported obesity rates for adolescents in different urban and rural areas are inconsistent. We examined indicators of healthy and unhealthy dietary patterns among 1863 adolescents aged 13–18 years with a healthy or excess body weight attending 23 secondary schools in four different settlement types across the Otago region, New Zealand. An online survey included demographics and dietary behaviours. Height and weight were measured, and body mass index was calculated. New Zealand defined urban and rural settlement types were used. Home addresses determined a small area-level index of deprivation. Data were analysed using Chi-square tests and ANOVA. A logistic model was fitted to estimate adjusted odds ratios of excess weight. The proportion of adolescents with a healthy weight differed (p p = 0.087). Sugar-sweetened beverage and fast-food consumption was more frequent in the most deprived areas (p p < 0.001). The most important associations with excess weight were area-level deprivation and ethnicity, but not settlement type. Prioritising socioeconomic factors irrespective of settlement type is necessary when developing interventions to improve dietary patterns and body weight status among adolescents

Diabetic retinopathy screening in New Zealand requires improvement: results from a multi‐centre audit

Abstract Objective: To determine whether diabetic retinal screening services and retinopathy referral centres in New Zealand meet the national guidelines for referral and assessment of screen detected moderate retinal and mild macular diabetic eye disease. Methods: Diabetic retinal screening pathways and the data collected at four main centre retinal screening services were described and compared with recommendations in the national diabetes retinal screening guidelines. A retrospective audit of photoscreen detected moderate retinopathy (grade R3), and mild maculopathy (grades M2B and M3) during May to August 2008 was undertaken. Data collected by retinopathy referral centres were used to examine the follow‐up of screen detected cases and to make comparisons with the national recommendations. Results : All four screening services used the guidelines for grading, but the recommended dataset was incomplete. Not all recorded data were readily accessible. The retinal photos of 157 (2.4%) patients were graded as R3, M2B, M3 or a combination. The proportion of those screened with these grades varied across the four centres from 1.2% to 3.4%. Follow‐up of the 157 screen positive patients did not always comply with guideline recommendations. Seventy five (48%) were referred for review by an ophthalmologist as recommended, 45 (60% of referred) were seen within the recommended six months. Nine patients (15% of the 60 with a documented assessment) were referred for or received laser treatment at 12‐months follow‐up. Conclusion: Quality diabetic retinal screening data systems and quality assurance programs are required to improve the monitoring and quality of retinal screening in New Zealand

Capture‐recapture using multiple data sources: estimating the prevalence of diabetes

Abstract Objective: To examine the potential for using multiple list sources and capture‐recapture methods for estimating the prevalence of diagnosed diabetes. Method: A model‐averaging procedure using an adjusted Akaike's Information Criterion (QAICc) was used to combine capture‐recapture estimates from log‐linear models obtained from simultaneously analysing four sources of data. The method was illustrated using four separate lists of patients with diabetes, resident in Otago, New Zealand. Results: Eighteen candidate models with a QAICc weight of more than 0.01 were obtained. A total of 5,716 individuals were enrolled on one or more of the four lists, of whom 379 (6.6%) appeared on all four lists and 1,670 (29.2%) appeared on one list only. The model‐averaged estimate of the total number of people with diagnosed diabetes was 6,721 (95% CI: 6,097, 7,346). The age‐standardised prevalence was 3.70% (95% CI: 3.36–4.04%) for the total population and 4.45% (95% CI: 4.03–4.86) for adults aged 15+ years. Conclusions: Estimated diabetes prevalence was consistent with national survey results. Capture‐recapture methods, combined with model averaging, are a cheap, efficient tool to estimate the prevalence of diagnosed diabetes. Implications: This method provides a relatively easy way to estimate the prevalence of diagnosed diabetes using routinely collected diabetes information, thus providing the opportunity to monitor the diabetes epidemic and inform planning decisions and resource allocation

Adolescents&rsquo; School Travel and Unhealthy Snacking: Associations with School Transport Modes, Neighbourhood Deprivation, and Body Weight

Active transport to and/or from school (ATS), alone or combined with motorised transport, provides an opportunity to increase adolescents&rsquo; physical activity levels to prevent obesity. However, travel through and exposure to an unhealthy food environment en route to school may have unintended consequences, specifically unhealthy snacking. This study examined the association between adolescents&rsquo; unhealthy snack food/soft drink purchases/consumption during the journey to and from school and their school transport modes, neighbourhood deprivation, and body weight. Adolescents (n = 660, age: 15.3 &plusmn; 1.3 years, 51.7% female) from 11 schools in the Otago region, New Zealand, completed an online survey and anthropometry. Data were analysed using &chi;2 test and logistic regression. Overall, 36.7% of adolescents purchased/consumed unhealthy snack foods and 25.9% purchased/consumed soft drinks at least once during their weekly school trips. ATS and mixed transport users reported more frequent unhealthy snack food/soft drinks purchases/consumption on the way to school than motorised transport users. Neighbourhood deprivation, but not body weight, was positively associated with unhealthy snack food/soft drink purchases/consumption during the school journey. Our findings highlight the importance of considering not only travel mode shift but also the obesogenic environment and unhealthy food/drinks purchases/consumption during adolescents&rsquo; school journeys, particularly in lower socio-economic areas, to prevent obesity

Proximal and distal influences on dietary change among a diverse group with prediabetes participating in a pragmatic, primary care nurse-led intervention: A qualitative study

Objective: To understand motivators, facilitators and challenges to dietary change amongst a diverse sample of New Zealanders with prediabetes participating in a primary care nurse-led individualised dietary intervention. Design: A qualitative study involving semi-structured, face-to-face interviews with a stratified sample of adults with prediabetes and body mass index ≥ 25kg/m2, purposefully selected from a larger 2-year primary care-based prediabetes dietary intervention study. Thematic analysis was undertaken. A socio-ecological model guided interpretation. Setting: Hawke\u27s Bay, Aotearoa/New Zealand, April 2018-March 2020. Participants: Fifty-eight people aged 28-69 years, with similar numbers of men and women, indigenous Māori and non-Māori, and those who had and had not regressed to normoglycaemia at 6-months. Results: Motivators for wanting to make dietary changes were determination not to progress to diabetes; wanting to be healthy and contribute to others; and encouragement by others. Facilitators for adopting and maintaining changes were a strong desire to be healthy; personal determination; and feeling supported. Challenges were compromised control over life and environmental factors; feeling unsupported by others; social occasions; financial constraints; and living with other health conditions. Developing their own strategies to overcome challenges was empowering, enabling a sense of control. These factors were similar across demographic and glycaemic outcome groups. Conclusions: Influences on dietary change involved personal, interpersonal, organisational, environmental, and policy factors. Although findings appeared similar across groups, dietary interventions need to address the specific ways motivators, facilitators and challenges manifest for individuals and social groups, and be tailored accordingly within the context of the wider obesogenic and socioeconomic environment